January 25, 2008

A software that can diagnose diseases!

The Union Health Minister, Dr Anbumani Ramadoss’ plans to make rural postings compulsory for the MBBS students has been dismissed as unworkable by many.

But here is an alternative on offer — a ‘clinical decision support software’ that even minimally trained health workers in remote rural areas can apparently deploy to make ‘intelligent’ diagnosis based on symptoms keyed in by the user.

Tested for accuracy


“We have tested NxOpinion for accuracy, usability and adaptability to local conditions in trials across 200 patients at the Nizam’s Institute of Medical Sciences, Hyderabad. The diagnosis made by the software virtually matched that of fully-qualified physicians. This conforms to the diagnostic accuracy rate of 94 per cent that we have reported across patient encounters in different world locations,” claimed Dr Joel C. Robertson, creator of the software and CEO of the Michigan-based Robertson Technologies.

“We are currently talking to the Central as well as various State Governments about the feasibility of adopting NxOpinion, including its local language versions, under the National Rural Health Programme,” Dr Robertson told Business Line. The software, built on a standard Microsoft.Net platform, can be loaded on to any notebook or desktop computer and run locally without requiring Internet access.

Incorporating a proprietary ‘Bayes theory-derived probabilistic inference engine’ that scans a medical knowledgebase of over 1,000 disease profiles, the NxOpinion software offers likely diagnosis and best treatment options based on the age, sex, general health profile and symptoms displayed by the patient.

Moreover, the technology platform is claimed to be scalable; the disease prevalence data can be changed for more accurate diagnosis by region.

Clinical reasoning


“The software is basically designed to mimic skilled clinical reasoning. Suppose a 45-year-old man complains of chest pain, it then asks him to specify the quality of pain (whether dull or intense; what position or activity aggravates or lessen the pain) and further prompts the health worker to check for pulse rate, blood pressure and cold or sweaty skin. If all these are in the affirmative, then the software would indicate, say 53.70 per cent probability of myocardial infarction. In case, the onset of pain is sudden and radiating to the neck, chest and shoulders, the probability rises to 98.62 per cent or so,” Dr Robertson informed.

But will such a tool really pass muster and gain acceptance with the medical fraternity? “No, we cannot support it. There is no substitute to a doctor, who alone has the knowledge and experience to make proper diagnosis. Tools of this kind will be liable to misuse by the thousands of quacks who illegally dispense treatment,” said Dr M. Abbas, National President, Indian Medical Association (IMA).

Dr Robertson, on his part, clarified that NxOpinion is not a freely marketable product and will be licensed only to health workers specifically approved by the Government. This includes accredited social health activists and informal rural practitioners who would act as an interface between the village community and the public health system.

Dr Abbas, however, maintained that the doctor’s role cannot be replaced by paramedics and neither can there be a simple technology quick fixes for rural healthcare problems. The Government has to provide basic facilities to enable doctors to function in rural areas, he added.

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